Surgeon brought Army experience to workplace emergency

Officials wheel Joe Castano, 31, from an Acadian Ambulance to an awaiting helicopter, which flew him to University Hospital. Castano got stuck in a piece of machinery at Bates Container in Von Ormy Monday night, and a University Hospital surgeon had to amputate his leg at the scene.

A University Hospital surgeon was called in to an industrial accident Monday night to help remove a man stuck in a piece of machinery.

Photo By University Hospital

Dr. Jayson Aydelotte, a trauma surgeon for University Hospital, said his 13-year history as a trauma surgeon in the U.S. Army helped him to think quickly during an operation at a corrugated boxes facility Monday night. Bexar County officials said Aydelotte amputated a worker's leg after the employee's limb got lodged in a piece of machinery, performing the first in-field operation of its kind. The worker, 31-year-old Joe Castano, is recovering at University Hospital. Photo courtesy of University Hospital

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Trauma surgeon Dr. Jayson Aydelotte has performed about 100 amputations in his 13 years in the U.S. Army — many during two tours in Iraq — but his first field surgery took place late Monday at a Southwest Side plant after a worker's leg got lodged in a machine.

Joe Castano, 31, was stuck between two giant rollers and the limb had to be amputated on the spot, Bexar County officials said. With the help of several emergency responders, it took Aydelotte about 10 minutes to conduct the operation — typically, amputations take about 30 minutes, he said.

“Amputations surround me,” said Aydelotte, 40. “I did tons of bad extremity explosion injuries; lots and lots of amputations in the Army. Anybody would have done the same thing I did last night.”

Castano declined to be interviewed and requested the specifics of his medical treatment be kept confidential.

He reportedly was operating an industrial belt pulley at Bates Container, a corrugated box facility in the 10600 block of Fischer Road in Von Ormy, when he stepped into an area where he shouldn't have been about 10 p.m. Monday, a company spokesman told a local TV station.

An officer responding to the 911 call found Castano standing on one foot, with his left leg twisted between the rollers.

Bexar County officials then summoned the San Antonio Fire Department's Technical Rescue Team, an ambulance, an AirLife helicopter — and a trauma surgeon.

“The rescue crews and the engineers on site didn't feel there was any way they could safely remove parts or pieces of this device in a timely manner,” said Dr. Craig Manifold, medical director of San Antonio EMS. “So the decision was made to extricate the patient from the device.”

Getting the call at University Hospital was Aydelotte, who had recently helped the hospital come up with procedures for in-field surgeries. He quickly began to look for a helper and found a medical student.

“We were kind of in a hurry to leave, and I needed someone who was really familiar with anatomy,” Aydelotte said. “She just happened to be nearby, and it was unbelievable. I wish I could tell you the details of the incident.”

At the plant, Aydelotte and the student were assisted by AirLife, San Antonio EMS and Acadian Ambulance personnel.

Once the man was freed, the helicopter flew Castano to University Hospital, where he was listed Tuesday in stable condition, officials said.

None of Bates' four facilities in Texas has been investigated by OSHA before.

Guy Sanders, the vice president of Bates' San Antonio division, did not return phone calls or emails seeking comment.

The operation was an unusual one for San Antonio.

University Hospital staff recalled a similar incident that occurred in the early 2000s, but Manifold said performing surgery at the site of an accident is uncommon and takes place only when the patient's life is at risk.

“At that point in time, we've made the decision that we won't be able to salvage the limb, and our preference is always if we can bring part of the equipment in with the patient to the OR,” Manifold said. “But we do occasionally run into these circumstances where we're not able to do that.”

Aydelotte had never performed an amputation in the field but has had plenty of experience in trauma medicine.

Aydelotte first made headlines at a trauma hospital in 2009 in Tikrit, Iraq, after a 22-year-old infantryman, Brendan Marrocco, was struck by a roadside bomb on Easter. Aydelotte helped him become the first veteran of Iraq or Afghanistan to survive losing both legs and both arms in combat.

Three limbs had been blown off and his left leg “was hanging literally by a thread,” Aydelotte told the New York Times. “Any one of his injuries was life-threatening.”

Two years later, Aydelotte, a San Antonio native, left the Army to return home.

Now 26, Marrocco lives independently in a home in Staten Island tailored to his needs. He's on a list for a double arm transplant, his father said.

“Dr. Aydelotte was the one responsible, basically, for keeping Brendan alive,” Alex Marrocco said. “The military has some very dedicated and extremely knowledgeable people. I'm not surprised at all that Dr. Aydelotte would be capable of doing what he did in San Antonio.”